Provider Demographics
NPI:1023207149
Name:MENCITA DABU MASANGKAY DMD INC.
Entity Type:Organization
Organization Name:MENCITA DABU MASANGKAY DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENT/OWNERIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MENCITA
Authorized Official - Middle Name:DABU
Authorized Official - Last Name:MASANGKAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-741-7788
Mailing Address - Street 1:500 ALFRED NOBEL DR STE 145
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1839
Mailing Address - Country:US
Mailing Address - Phone:510-741-7788
Mailing Address - Fax:519-741-7705
Practice Address - Street 1:500 ALFRED NOBEL DR STE 145
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1839
Practice Address - Country:US
Practice Address - Phone:510-741-7788
Practice Address - Fax:519-741-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44028305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93406-01OtherDENTICAL PROVIDER ID
CA522631OtherDENTICAL PIN